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Based on medical record review and staff interview it was determined the registered nurse (RN) failed to document an assessment and nursing interventions for one (1) of two (2) patients located in a room which experienced a sewer line break (patient #2). This failed practice has the potential to adversely affect the care of all patients. Findings include:

1. Entrance conference was conducted with both the Interim Chief Executive Officer (CEO) and Associate Administrator in the midmorning of 6/1/10. The Associate Administrator stated a sewer line break occurred in a room at 1100 on 5/26/10. This room contained two (2) patients, including patient #2.

2. Review of the 5/26/10 nursing notes for patient #2 revealed no documentation of the sewer line break. The record lacked an assessment of the patient or any nursing interventions which were provided related to this incident.

3. During the afternoon of 6/2/10 this record was reviewed and discussed with both the 3 East Nurse Manager and the 3 East Clinical Manager. They acknowledged the RN failed to document an assessment and nursing interventions related to the incident.

Base on review of the medical record and staff interview it was revealed the hospital failed to ensure the medical record contained documentation of a consultative evaluation of positive culture results for one (1) of one (1) patients reviewed who received positive culture results post exposure (patient #2). This failed practice has the potential to adversely impact the care provided to patients with positive culture results. Findings include:

1. Entrance conference was conducted with both the Interim Chief Executive Officer (CEO) and Associate Administrator in the mid morning of 6/1/10. The Associate Administrator stated a sewer line break occurred in a room at 1100 on 5/26/10. This room contained two (2) patients, including patient #2.

2. Review of the record revealed the patient was seen by an Infectious Disease Physician as a result of a potential exposure to sewage on 5/26/10. The Physician's orders for patient #2 revealed a 5/26/10 order, which included an order for a Methicillin Resistant Staph Aureus (MRSA) nasal screen.

3. Review of nursing notes for 5/27/10 at 1330 revealed the nurse noted in part: "I received call from Microbiology telling me that NP (nasopharyngeal) swab from yesterday was positive for MRSA."

4. Review of the nursing notes for 5/27/10 at 1437 and 1518 revealed the family was upset with the culture results. The nurse documented the family wanted to speak with Administration. The nurse documented the Associate Administrator and Infectious Disease Physician met with a family member.

5. Review of progress notes and consultations revealed the record lacked documentation from the Infectious Disease Physician to reflect he evaluated the positive culture results and discussed the findings and plan of treatment with the patient.

6. During the afternoon of 6/2/10 this record was reviewed and discussed with both the 3 East Nurse Manager and the 3 East Clinical Manager. They agreed with these findings.

7. These findings were also discussed with the Associate Administrator, in the afternoon of 6/2/10. He indicated that he and the Infectious Disease Physician met with the family member of patient #2 who was upset. He stated he did not document in the medical record.

Based on medical record review and staff interview it was determined the hospital failed to ensure the medical record contained laboratory reports ordered for one (1) of two (2) patients reviewed (patient #1). This failed practice has the potential to adversely affect the care and treatment of all patients. Findings include:

1. Review of the 5/26/10 physician's orders for patient #1 revealed she had an order for Methicillin Resistant Staph Aureus (MRSA) nasal surveillance cultures and groin culture for Extended Spectrum Beta Lactamase (ESBL).

2. Review of the record for patient #1 revealed no record of the ESBL culture results. A phone interview was conducted with the microbiology laboratory technician in the early afternoon of 6/2/10. She indicated the laboratory had no record of an ESBL culture for patient #1. She noted the test had not been performed.

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Based on medical record review and staff interview it was determined the hospital failed to ensure the discharge summary included information related to the patient's exposure to sewage contamination and provisions for related followup care for one (1) of one (1) involved patients who had a discharge summary completed (patient #1). This failed practice has the potential to adversely affect the continuity of care of all patients. Findings include:

1. Review of the medical record for patient #1 revealed the nurse documented, in part, the following at 1105 on 5/26/10: "Patient covered in material from burst pipe".

2. Review of a 5/26/10 Consultation Summary revealed the patient was seen by an Infectious Disease Physician as a result of the exposure to the sewage. Review of the consultation summary revealed the Physician documented, in part, the following: "I reviewed symptoms that she would need to watch for and consider. I mentioned some surveillance tests that would need to be done to ensure she was not colonized with resistant organisms."

3. Review of the 5/27/10 Discharge Summary for patient #1 revealed no reference to the sewage exposure or any related provisions for follow-up care.

4. During the afternoon of 6/2/10 this record was reviewed and discussed with both the 3 East Nurse Manager and the 3 East Clinical Manager. They agreed with these findings.

5. The Discharge Summary was also discussed and reviewed with the Associate Administrator, in the afternoon of 6/2/10, and he agreed with these findings.

Based on medical record review and staff interview it was determined the hospital failed to provide discharge instructions which included necessary plans for post hospital care for two (2) of two (2) patients exposed to a sewer break (patients #1 and 2). This failed practice has the potential to negatively impact the post hospital services and care of all patients. Findings include:

1. Entrance conference was conducted with both the Interim Chief Executive Officer and Associate Administrator in the mid morning of 6/1/10. The Associate Administrator stated a sewer line break occurred in a room which contained patients #1 and #2.

2. Review of the medical record for patient #1 revealed the nurse documented, in part, the following at 1105 on 5/26/10: "Patient covered in material from burst pipe".

3. Review of a 5/26/10 Consultation Summary revealed the patient was seen by an Infectious Disease Physician as a result of the exposure to the sewage. Review of the consultation summary revealed the Physician documented, in part, the following: "I reviewed symptoms that she would need to watch for and consider..."

4. Review of the 5/27/10 Discharge Summary for patient #1 revealed the patient was discharged home on that date.

5. Review of the 5/27/10 nurses notes for patient #1 revealed the nurse documented, in part, at 1829: "...Patient left floor refused to sign any discharge papers, and refused discharge education..."

6. Review of the medical record revealed it contained no discharge instructions.

7. During the afternoon of 6/2/10 this record was reviewed and discussed with both the 3 East Nurse Manager and the 3 East Clinical Manager. They indicated that discharge instructions are prepared, reviewed with the patient and a signed copy is placed in the record. The Nurse Manager noted the nurse should have documented on the instructions that the patient refused to sign and placed it in the record.

8. Review of the physician's orders for patient #2 revealed a 5/26/10 order for post exposure testing. On 5/27/10 a test result revealed the presence of Methicillin Resistant Staph Aureus (MRSA).

9. Review of the physician's orders revealed a 5/27/10 Protocol for MRSA Management which was initiated at 1500. It included an order for the patient to receive medicated ointment in both nares twice a day for five (5) days.

10. Review of the Discharge Summary Sheet, signed by patient #2 on 5/29/10, revealed it lacked any documentation of medical followup or home instructions for treatment of the MRSA.

11. During the afternoon of 6/2/10 this record was reviewed and discussed with both the 3 East Nurse Manager and the 3 East Clinical Manager. They agreed with these findings.